title: Parathyroidectomy improves cardiovascular outcome in nondiabetic dialysis patients with secondary hyperparathyroidism.
abstract: OBJECTIVE
  Secondary hyperparathyroidism and its associated abnormalities in mineral metabolism and haemodynamic changes increase the cardiovascular risk in patients with end-stage renal disease (ESRD). Our objective was to determine the association of parathyroidectomy (PTX) with major cardiovascular events in nondiabetic dialysis patients with severe secondary hyperparathyroidism (SHPTH).
  
  
  METHODS
  We performed a cohort study with fifty-three nondiabetic ESRD patients who were treated with maintenance haemodialysis and who had intact parathyroid hormone (PTH) levels > 800 pg/ml. Participants received either only medical therapy or medical therapy and total PTX with autotransplantation for SHPTH.
  
  
  METHODS
  We evaluated the associations between PTX and major cardiovascular events including death, cerebrovascular accident and myocardial infarction. The biochemical and haemodynamic changes associated with PTX were measured.
  
  
  RESULTS
  During the mean follow-up of 72 months, twenty-three patients received only medical treatment (medical group) while thirty patients underwent PTX in addition to medical treatment (PTX group). The two groups were comparable in respect of baseline characteristics. PTX group was found to be associated with a reduced incidence of major cardiovascular events (P = 0·021). A multiple Cox regression analysis showed that the variable significantly associated with major cardiovascular events was treatment modality (medical therapy vs medical therapy and parathyroidectomy, hazard ratio = 26·12, 95% CI = 1·30-526·27, P = 0·033). Blood pressure, haemoglobin, alkaline phosphatase, calcium, phosphate and calcium × phosphate product significantly improved after PTX.
  
  
  CONCLUSIONS
  PTX was associated with better cardiovascular outcome in nondiabetic dialysis patients with severe SHPTH.
authors.affiliation: Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan.
authors.forename: Ho-Cheng
authors.initials: HC
authors.lastname: Lin
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Chen
authors.forename: Huey-Shyan
authors.initials: HS
authors.lastname: Lin
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
authors.forename: Shiuh-Inn
authors.initials: SI
authors.lastname: Liu
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Huang
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Huang
authors.forename: Chun K
authors.initials: CK
authors.lastname: Huang
authors.forename: Tsu-Yuan
authors.initials: TY
authors.lastname: Chang
authors.forename: Yun-Te
authors.initials: YT
authors.lastname: Chang
authors.forename: Po-Tsang
authors.initials: PT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D006435:Renal Dialysis; D012307:Risk Factors